Controlling catheter flow

ABSTRACT

A catheter assembly includes an elongate member and a balloon. The elongate member defines at least one lumen and an outer surface. The outer surface defines at least one opening in fluid communication with the at least one lumen. The balloon is disposed within the at least one lumen. The balloon is inflatable such that a portion of the balloon expands from the at least lumen through the at least one opening. The expansion of the balloon increases the flow restriction through the at least one opening compared to the flow restriction through the at least one opening when the balloon is in a deflated condition. Methods for using a catheter assembly to remove occlusive material from a catheter are also described.

This application is a divisional of U.S. application Ser. No.13/792,376, filed Mar. 11, 2013, the entire content of which isincorporated by reference herein.

TECHNICAL FIELD

The present disclosure generally relates to catheter assemblies, andmore particularly, to controlling flow through catheter assemblies.

BACKGROUND

Catheters are flexible medical instruments that facilitate withdrawaland introduction of fluids from and to body cavities, ducts, andvessels. Catheters may have particular application, for example, in ahemodialysis procedure where blood is withdrawn from a blood vessel fortreatment, and subsequently returned to the blood vessel forcirculation. During some hemodialysis procedures, a multiple lumencatheter is inserted into a body and blood is withdrawn through anarterial lumen of the catheter. The removed blood is directed, viaextension tubes, to a hemodialysis machine which dialyzes, or purifies,the blood to remove waste and toxins. The purified blood is thenreturned through a venous lumen of the catheter.

Some multilumen catheters for dialysis treatment are placed within apatient for use over extended periods of time. During such use, one ormore of the catheter lumens can narrow and/or occlusive material canform on any surface of the catheter segment implanted within the body.This occlusive material can develop into a blockage developing in anopening or openings of the catheter. In some instances, blood caninfiltrate lumens of the catheter despite the presence of a locksolution such as heparin. The infiltration of blood can result in lumennarrowing, occlusion and/or bacterial colonization of one or more of thecatheter lumens. These issues can inhibit the proper function of thecatheter, result in patient complications, and/or necessitatereplacement of the catheter.

SUMMARY

In general, according to one aspect of the present disclosure, acatheter assembly includes an elongate member and a balloon. Theelongate member defines at least one lumen and an outer surface. Theouter surface of the elongate member defines one or more openings influid communication with the at least one lumen.

The balloon is disposed within the at least one lumen and is inflatablesuch that at least a portion of the balloon expands from the at leastone lumen and through the at least one opening to increase flowrestriction through the at least one opening, as compared to flowrestriction through the at least one opening with the balloon in adeflated condition. The balloon is more compliant than the elongatemember and has a volume that expands upon inflation. The balloon, insome embodiments, maintains a zero-fold profile in the deflatedcondition. In certain embodiments, the balloon is inflatable intosealing engagement with a periphery of the at least one opening. Incertain embodiments, the balloon is inflatable to extend at least one ofradially and distally beyond the outer surface of the elongate member.

In some embodiments, the balloon is formed of latex or polyurethane andthe elongate member is formed of silicone or other biocompatiblepolyurethanes. In certain embodiments, the balloon is coated with one ormore of an anti-thrombotic agent, an antimicrobial agent, and abiomimetic agent. The anti-thrombotic agent can comprise, for example, abase polymer layer including one or both of a biostable polymer and abioabsorable polymer. Additionally or alternatively, the balloon can becoated with an anti-restenotic agent (e.g., paclitaxel or a −limusdrug).

The catheter assembly can include a second balloon. The elongate membercan define dual lumens where the balloon is a first balloon disposedwithin one of the lumens and the second balloon is disposed within theother lumen. In some embodiments, the elongate member includes a septumextending therethrough. The first and second balloons can be secured tothe septum and inflatable through fluid communication with an inflationlumen at least partially defined by the septum.

In certain embodiments, the elongate member defines at least one distalend opening and at least one side opening. The balloon can be inflatableto restrict flow through the at least one distal end opening and/or theat least one side opening.

According to another aspect, a catheter tip assembly includes a tubularbody and a balloon supported within the tubular body. The tubular bodyhas an outer surface that defines at least one opening. The tubular bodyhas a proximal end portion and a distal end portion. The proximal endportion of the tubular body is securable to a distal end portion of anindependent catheter body.

In some embodiments, the balloon is an expandable septum. At least aportion of the expandable septum is expandable into the at least oneopening. In certain embodiments, the tubular body and the expandableseptum together define at least two inflation lumens and at least oneexternal lumen. The at least one opening is in fluid communication withthe at least one external lumen and the expandable septum can beinflatable through the at least two inflation lumens to expand into theat least one external lumen to restrict flow through the at least oneopening.

The expandable septum, in certain embodiments, defines at least twoport. Each port can be in fluid communication with a respective one ofthe at least two inflation lumens and each port is connectable in fluidcommunication to a respective internal lumen defined within a septumextending through the independent catheter body.

In some embodiments, a radio-frequency weld couples the proximal endportion of the tubular body to the distal end portion of the independentcatheter body.

According to yet another aspect, a method for removing occlusivematerial from a catheter includes delivering inflation fluid to aballoon disposed within at least one lumen defined by an elongate memberof a catheter, expanding the balloon to at least partially extendthrough at least one opening defined by an outer surface of the elongatemember, and clearing occlusive material from the at least one opening.

Expanding the balloon can include expanding the balloon to extend one orboth of radially and distally beyond the one or more openings in adirection toward an outer surface of the elongate member. The method caninclude occluding the at least one opening with the balloon uponinflation of the balloon. The method can include maintaining the balloonin an inflated state to prevent flow of fluid through the at least oneopening.

Delivering inflation fluid to the balloon can include filling theballoon with saline until the balloon expands to a volume sufficient toclear occlusive material from the at least one opening and to completelyocclude the at least one opening. The method can include deflating theballoon.

Embodiments can include one or more of the following advantages.

One or more balloons of the catheter assembly can be inflated to limitand/or prevent side slots and/or lumens of the catheter of the catheterassembly from being occluded when the catheter is positioned within abody for extended periods of time. The balloons can be inflated tocompletely retain lock solution within the catheter and/or increaseinsertablity of the catheter by increasing the stiffness of thecatheter. In embodiments, the one or more balloons can be coated with ananti-thrombotic agent so that, upon inflation, the anti-thrombotic agentcan be positioned in close proximity to the occlusive material toincrease the effectiveness and longevity of the catheter assembly bylimiting the build up of occlusive material.

The balloons of the catheter assembly are internal to the catheter andexpandable through one or more openings defined by the catheter to clearan occlusion and/or to retain a lock solution. As compared to a balloondisposed on an outer surface of a catheter, the internal positioning ofthe balloon can reduce the catheter system profile and, in someinstances, facilitate insertion of the catheter.

Other aspects, features, and advantages will be apparent from thedescription, drawings, and the claims.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a catheter assembly.

FIG. 2A is an enlarged, side view of a distal end portion of thecatheter assembly shown in FIG. 1 with a balloon assembly of thecatheter assembly shown in an uninflated condition.

FIG. 2B is an enlarged, end-axial view of the catheter assembly shown inFIG. 1 with the balloon assembly shown in the deflated condition.

FIG. 3A is an enlarged, side view of the distal end portion of thecatheter assembly shown in FIG. 1 with the balloon assembly shown in aninflated condition.

FIG. 3B is an enlarged, end-axial view of the catheter assembly shown inFIG. 1 with the balloon assembly shown in the inflated condition.

FIG. 4 is an enlarged, cross-sectional view taken along line A-A of FIG.2A.

FIG. 5A is a side view of a distal end portion of a catheter and acatheter tip assembly.

FIG. 5B is a cross-sectional view of the catheter tip assembly shown inFIG. 5A.

FIG. 6A is a side view of the distal end portion of the catheter of FIG.5A shown secured to the catheter tip assembly of FIG. 5A with theexpandable septum of the catheter tip assembly shown in a deflatedcondition.

FIG. 6B is an end view of the catheter tip assembly shown in FIG. 6Awith the expandable septum of the catheter tip assembly shown in thedeflated condition.

FIG. 7A is a side view of the distal end portion of the catheter of FIG.5A shown secured to the catheter tip assembly of FIG. 5A with theexpandable septum of the catheter tip assembly shown in an inflatedcondition.

FIG. 7B is an end view of the catheter tip assembly shown in FIG. 7Awith the expandable septum of the catheter tip assembly shown in theinflated condition.

FIG. 8 is a perspective view of a distal end portion of another catheterassembly.

FIG. 9A is an enlarged, side view of the distal end portion of thecatheter assembly of FIG. 8 with a balloon of the catheter assemblybeing shown in a deflated condition.

FIG. 9B is an enlarged, cross-sectional view taken along line B-B shownin FIG. 9A.

FIG. 10A is an enlarged, side view of the distal end portion of thecatheter assembly of FIG. 8 with the balloon of the catheter assemblybeing shown in an inflated condition.

FIG. 10B is an enlarged, cross-sectional view taken along line C-C shownin FIG. 10A.

DETAILED DESCRIPTION

As used herein, the term “clinician” refers to a doctor, nurse, or othercare provider and may include support personnel. The terms “proximal” or“trailing” each refer to the portion of a structure closer to aclinician, and the terms “distal” or “leading” each refer to a portionof a structure farther from the clinician. As used herein, the term“subject” refers to a human patient or other animal.

Referring now to FIGS. 1, 2A-2B, and 4, a catheter assembly 100 includesan elongate member 110 that extends distally from a hub 120 and aquadruple-lumen extension tube assembly 130 that extends proximally fromthe hub 120. The elongate member 110 is a catheter having an outersurface 110 a, an inner surface 110 b, and, in some embodiments, havinga tubular body. The elongate member 110 defines one or more sideopenings 112 and, in some embodiments, supports one or more cuffs 140.In use, as described in further detail below, the portion of thecatheter assembly 100 distal to the cuff 140 is implanted within thebody of a subject, and the portion of the catheter assembly 100 proximalto the cuff 140 remains outside of the body of the subject in a positionaccessible to a clinician. Bodily fluid (e.g., blood) can be withdrawnfrom the subject and/or returned to the subject through the sideopenings 112. As also described in further detail below, a first balloon150 a and a second balloon 150 b are disposed adjacent the side openings112 such that inflation and/or deflation of the first and secondballoons 150 a, 150 b can remove blockage from the side openings 112and/or can occlude the side openings 112 to hold a lock solution withinthe catheter assembly 100 between periods of treatment (e.g., during aninterdialytic period).

The elongate member 110 can be formed of a rigid polymeric material suchas silicone or other biocompatible polyurethane. The elongate member 110includes a septum 114 extending at least the length of the elongatemember and defining a longitudinal axis “L.” The inner surface 110 b ofthe elongate member 110 and side surfaces 114 a of the septum 114together define a first lumen 116 and a second lumen 118. One of thelumens 116, 118 can function as an arterial lumen and the other of thelumens 116, 118 can function as a venous lumen during a dialysisprocedure. The first lumen 116 includes a first distal end opening 116a, and the second lumen 118 includes a second distal end opening 118 a.

The one or more side openings 112 can include a first side opening 112 ain fluid communication with the first lumen 116 and a second sideopening 112 b in fluid communication with the second lumen 118. A firstballoon 150 a is adjacent the first side opening 112 a and the secondballoon 150 b is adjacent the second side opening 112 b communicatingwith the second lumen 118. Each side opening 112 a, 112 b can havegeometric shapes including polygonal configurations, circularconfigurations, and/or combinations thereof.

The septum 114 defines one or more inflation lumens 115 extending atleast axially along the length of the septum 114, from the hub 120 tothe balloons 150 a, 150 b. The one or more inflation lumens 115 caninclude, for example, a first inflation lumen 115 a and a secondinflation lumen 115 b. The first and second inflation lumens 115 a, 115b are positionable in fluid communication with an inflation source suchas, for example, a syringe pre-filled with an inflation fluid (e.g.,saline). It should be appreciated that the inflation lumen can beformed, for example, during the extrusion of the elongate member 110.

The septum 114 supports the first and second balloons 150 a and 150 b.The first balloon 150 a can be mounted to one side of the septum 114,and the second balloon 150 b can be mounted on the opposite side of theseptum 114. It should be appreciated that the first and second balloons150 a, 150 b can each be mounted to respective sides of the septum 114using, for example, adhesives. Each of the interiors of the balloons 150a and 150 b is in fluid communication with one or both of the inflationlumens 115 a, 115 b through one or more ports 115 c, 115 d defined atrespective ends of the inflation lumens 115 a, 115 b. The ports 115 c,115 d may extend through or terminate within the interior of therespective balloons 150 a, 150 b. The balloons 150 a, 150 b areinflatable from a deflated condition to an inflated condition uponreceiving inflation fluid from the inflation source.

In the deflated condition, each balloon 150 a, 150 b is supported by theseptum 114 to permit substantially unrestricted fluid communicationthrough the respective lumen 116, 118, the respective side opening 112a, 112 b, and/or the respective distal end opening 116 a, 118 a. Theballoons 150 a, 150 b, in some embodiments, can maintain a zero-foldprofile in the deflated condition. In some embodiments, the balloons 150a, 150 b are at least partially recessed within the septum 114.

In the inflated condition, each balloon 150 a, 150 b is inflated to avolume within the respective lumen 116, 118 sufficient to at leastpartially restrict fluid flow through the respective lumen 116, 118, therespective side opening 112 a, 112 b, and/or the respective distal endopening 116 a, 118 a. In certain embodiments, the balloons 150 a, 150 bcan be inflated into sealing engagement with the inner surface 110 b ofthe elongate member 110 (e.g., upstream of the respective side openings112 a, 112 b). In some embodiments, each balloon 150 a, 150 b can beinflated to occlude completely the respective side opening 112 a, 112 band/or the respective distal end opening 116 a, 116 b. As shown in FIGS.2A-3B, for example, the balloons 150 a, 150 b expand in a radial and/oraxial direction and can be inflated to extend radially and/or distallythrough the respective side opening 112 a, 112 b and/or the respectivedistal end opening 116 a, 118 a and extend outwardly of the outersurface 110 a of the elongate member 110. The balloons 150 a, 150 b canbe arranged to be independently inflatable or simultaneously inflatable.Moreover, it should be appreciated that, as used herein, the termballoon refers to any structure defining a volume and expandable uponintroduction of fluid into the volume and, thus, can include a unitaryarrangement of material and/or a multi-component arrangement securedtogether to form, for example, a bladder.

The balloons 150 a, 150 b can be produced using one or more of molding,blowing, dipping, and extruding. The balloons 150 a, 150 b can be formedof a very compliant, low durometer material with high elastomeric/lowfatigue properties. Balloons with such properties can be achievedthrough material selection and/or balloon dimensions (e.g., wallthickness). The elongate member 110 can be formed of one or morematerials exhibiting less compliant and higher durometer properties thanthose of the balloons 150 a, 150 b such that the expanded balloons 150a, 150 b deform to fill the respective side opening 112 a, 112 b and/orthe respective distal end opening 116 a, 118 a.

The balloons 150 a, 150 b can be formed of a compliant material (e.g.,one or more of latex, polyurethane, and silicone) to facilitate radialexpansion and/or axial expansion in response to introduction ofinflation fluid into the balloons 150 a, 150 b to move the balloons 150a, 150 b from the deflated condition (FIGS. 2A and 2B) to the inflatedcondition (FIGS. 3A and 3B). Similarly, it should be appreciated thatthe withdrawal of inflation fluid from the balloons 150 a, 150 b canresult in movement of the balloons 150 a, 150 b from the inflatedcondition to the deflated condition.

The extension tube assembly 130 includes a plurality of treatmentextension tubes 130 a and inflation extension tubes 130 b. Eachtreatment extension tube 130 a is in fluid communication with one of thelumens 116, 118, and each inflation extension tube 130 b is in fluidcommunication with one of the inflation lumens 115 a, 115 b. While twotreatment extension tubes and two inflation extension tubes are shown,additional treatment lumens and/or additional inflation lumens arepossible. For example, three or more treatment extension tubes can be influid communication with a corresponding number of lumens and three ormore inflation extension tubes can be in fluid communication with acorresponding number of inflation lumens.

Each extension tube 130 a, 130 b includes an elongate body portion 132extending proximally from the hub 120. A luer adapter 134 is secured toa proximal end portion of each elongate body portion 132 and supports aclamp 136 between the luer adapter 134 and the hub 120. Each lueradapter 134 is connectable, for example, to a hemodialysis machine (notshown) and/or the inflation source (not shown) and/or any device with astandard luer-taper/conical fitting such as fittings specified in ISO594. The clamp 136 is movable between clamped and unclamped positionsabout the elongate body portion 132 to control fluid flow through theelongate body portion 132. In the clamped position, the clamp 136substantially restricts (e.g., prevents) fluid flow through the elongatebody portion 132 and, in the unclamped position, the clamp 136 permitssubstantially unrestricted fluid flow through the elongate body portion132.

In an exemplary use, the catheter assembly 100 is inserted into asubject. The luer adapters 134 of the treatment extension tubes 130 aare secured to a treatment device (e.g., hemodialysis machine and theclamps 136 are moved to the unclamped position to permit flow of abodily fluid (e.g., blood flow) through the treatment extension tubes130 a as part of a medical procedure (e.g., hemodialysis). Aftercompletion of the medical procedure, a lock solution (e.g., a solutionincluding heparin) can be introduced into the lumens 116, 118 of thecatheter assembly 100, and the clamps 136 can be moved to the clampedposition to restrict flow through the treatment extension tubes 130 a.The luer adapters 134 of the treatment extension tubes 130 a can bedisconnected from the treatment device, and a syringe or other inflationsource can be secured to the inflation extension tube(s) 130 b to injectthe inflation fluid into one or both of the balloons 150 a, 150 b suchthat the balloons 150 a, 150 b inflate to obstruct flow through the sideand/or distal end openings of the elongate member 110. The extension ofthe inflated balloons 150 a, 150 b through the side openings 112 and/orthrough the distal openings 116 a, 118 a can reduce the likelihood of(e.g., prevent) occlusive material build-up and/or bacterialcolonization within the elongate member 110, each of which can resultfrom in vivo catheter placement for extended periods, such as thoseassociated with chronic hemodialysis catheters (e.g., about 30 days ormore).

To deflate the balloons 150 a, 150 b, for example, to perform anothermedical procedure, a syringe or other fluid removal source may beconnected to one of the inflation extension tubes 130 b to providesuction sufficient to withdraw the inflation fluid from within theballoons 150 a, 150 b. A desired amount of inflation fluid can be purgedfrom the balloons 150 a, 150 b for whole or partial deflation of theballoons 15 a, 150 b. In some embodiments, the inflation lumens 115 a,115 b allow bi-directional flow from and to the balloons 150 a, 150 b.Alternatively or additionally, the balloons 150 a, 150 b can be inflatedand/or re-inflated to clear occlusive material formed on or near theside openings 112 a, 112 b and/or distal end openings 116 a, 116 b ofthe elongate member 110.

While certain embodiments have been described, other embodiments arepossible.

For example, while the balloon assembly 150 has been described asincluding two balloons, other embodiments are additionally oralternatively possible. In some embodiments, the balloon assemblyincludes a single balloon. The single balloon, upon inflation, canexpand from the septum 114 in a direction transverse to the longitudinalaxis “L” and into one or both of the external lumens 116, 118. In use,one lumen is used to inject fluid while the other lumen is used to purgecontents and ensure complete charging of fluid.

As another example, while the catheter assemblies have been described ashaving a unitary construction, other embodiments are additionally oralternatively possible. For example, with reference to FIGS. 5A-5B,6A-6B, and 7A-7B, a catheter assembly 100′ includes a separate catheter210 and a catheter tip assembly 300. The elongate member 210 is acatheter having a distal end portion 210 a and a septum 212 extendingthrough the elongate member 210 along the axial length of the elongatemember 210. The septum 212 defines a first inflation lumen 214 and asecond inflation lumen 216 (shown in phantom), each extending to thedistal end portion 210 a of the elongate member 210.

The catheter tip assembly 300 includes an elongate tubular body 310having a proximal end portion 310 b and a distal end portion 310 a. Theelongate tubular body 310 has an inner surface 310 c and an outersurface 310 d. The elongate tubular body 310 defines one or more sideopenings 312 extending from the outer surface 310 d to the inner surface310 c. The elongate tubular body 310 includes a septum 320 extending atleast partially along an axial length of the tubular body 310. Incertain embodiments, the septum 320 extends the entire length of theelongate tubular body 310 and is formed of a compliant and expandablematerial to facilitate expansion of the entire septum 320 along thelength of the elongate tubular body 310.

The septum 320 defines inflation lumens 324 including a first inflationlumen 324 a and a second inflation lumen 324 b. The septum 320 includesa balloon 322 connected to a distal end portion of the septum 320 and influid communication with the first and second inflation lumens 324 a,324 b. The first and second inflation lumens 324 a, 324 b includerespective first and second ports 326 a, 326 b establishing fluidcommunication between the first and second inflation lumens 324 a, 324 band the balloon 322. A portion of the side surfaces 322 a, 322 b of theballoon 322 is secured to the inner surface 310 c of the elongatetubular body 310, and a proximal end portion of the balloon 322 can besecured adjacent the first and second ports 326 a, 326 b. Each of theinflation lumens 324 is dimensioned to permit passage of inflation fluidto inflate and/or deflate the balloon 322. In certain embodiments, theinflation lumens 324 permit bi-directional flow such that inflationfluid moves to the balloon 322 through one of the inflation lumens 324and an overflow of inflation fluid moves from the balloon 322 throughanother one of the inflation lumens 324.

The proximal end portion 310 b of the catheter tip assembly 300 issecured to the distal end portion 210 a of the tubular body 210. Forexample, the catheter tip assembly 300 can be welded to the tubular body210, such as with radio-frequency energy, along a weld line 250.Additionally or alternatively, the catheter tip assembly 300 can beover-molded onto the tubular body 210.

With the catheter tip assembly 300 and the tubular body 210 connected,the first and second inflation lumens 324 a, 324 b are in fluidcommunication with the first and second inflation lumens 214, 216 of theelongate member 210. Further, the connection of the catheter tipassembly 300 and the tubular body 210 creates a single septum defined bythe septum 212 of the elongate member 210, the septum 320 of the tubularbody 310, and the balloon 322 of the tubular body 310. As shown in FIG.6B, the inner surfaces of the single elongate assembly, together withthe septum 212 of the elongate member 210 and the septum 320 of thetubular body 310, define first and second lumens 330, 340 on oppositesides of the single septum 320.

With specific reference to FIGS. 7A and 7B, the expandable portion 322is inflatable to completely occlude the side openings 312 a, 312 band/or the respective distal end openings 330 a, 340 a. Similarly, theexpandable portion 322 is inflatable to extend radially and/or distallythrough the side openings 312 a, 312 b and/or through the distal endopenings 330 a, 340 a from or beyond the outer surface 310 d of thetubular body 310.

As still another example, catheter assemblies have been described asincluding multilumen catheters having a septum at least partiallydefining in each lumen. However, other lumen arrangements areadditionally or alternatively possible. For example, as seen in FIGS. 8and 9A-9B, a catheter 410 is an elongate tubular body having an innersurface 410 a and an outer surface 410 b. The inner surface 410 adefines a lumen 414 terminating at a distal end opening 414 a. Thetubular body 410 defines one or more side openings 412 extending fromthe outer surface 410 b to the inner surface 410 a. The one or more sideopenings 412 can include a first side opening 412 a and a second sideopening 412 b.

The elongate tubular body 410 supports a balloon 450 and defines aninflation lumen 416 in fluid communication with the balloon 450. Theballoon 450 is secured to the inner surface 410 a of the elongatetubular body 410 at a position proximal to a distal end portion of theelongate tubular body 410 and adjacent the side openings 412. As shownin FIG. 9B, for example, the balloon 450 can be between the sideopenings 412 a, 412 b in a direction transverse to the catheter 410. Theinflation lumen 416 is defined by the elongate tubular body 410.

In use, the balloon 450 is inflated to partially and/or completelyocclude one or both of the side openings 412 a, 412 b and/or the lumen414 while the distal end portion of the balloon 450 is proximal to thedistal end opening 414 a. In embodiments, the balloon 450 can beinflated to extend radially and/or distally through the side openings412 a, 412 b and/or the distal end opening 414 a of the tubular body410.

As still another example, any of the balloons described herein can becoated with an anti-thrombotic or anti-microbial agent. In someembodiments, the anti-thrombotic agent is heparin or p-selectin. Incertain embodiments, the anti-thrombotic agent includes a base polymerlayer having a biostable polymer (phosphorylcholine, for example) and/ora bioabsorbable polymer (examples include PLA, PGA, PLLA). With theanti-thrombotic agent coated on the balloons, the anti-thrombotic agentcan be continuously delivered by the inflated balloons to the sideand/or distal end openings to limit and/or prevent the build up ofocclusive material such as thrombus that may develop during prolonged invivo usage of chronic catheters. In some embodiments, the anti-microbialagent is one or more of chlorhexidine, silver, and benzalkoniumchloride. The anti-microbial agent can be impregnated within the balloonand/or within the elongate member. Additionally or alternatively, theanti-microbial agents can be encapsulated within a polymer matrix coatedon the elongate member. In certain embodiments, the elongate memberand/or balloon material is produced using polyurethane and biomimetictechnology, reducing the need for anti-thrombogenic material and/oranti-microbial material while performing a similar function.

As yet another example, while catheter assemblies have been described asused in hemodialysis procedures, the use of catheter assemblies in othermedical procedures is additionally or alternatively possible. Forexample, catheter assemblies can be used in procedures requiringlocalized drug delivery and/or in peritoneal dialysis.

Persons skilled in the art will understand that the structures andmethods specifically described herein and shown in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merely asexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. Additionally, the elements and features shownor described in connection with certain embodiments may be combined withthe elements and features of certain other embodiments without departingfrom the scope of the present disclosure, and that such modificationsand variations are also included within the scope of the presentdisclosure. Accordingly, the subject matter of the present disclosure isnot limited by what has been particularly shown and described.

What is claimed is:
 1. A method for removing occlusive material from acatheter, the method comprising: delivering inflation fluid to a balloondisposed within at least one lumen defined by an elongate member of acatheter; and expanding the balloon via the inflation fluid to at leastpartially extend through at least one side opening and at least onedistal end opening defined by an outer surface of the elongate member toclear occlusive material from each of the at least one side opening andthe at least one distal end opening.
 2. The method of claim 1, whereinexpanding the balloon includes expanding the balloon to extend at leastone of radially and distally beyond the at least one side opening andthe at least one distal end opening in a direction toward an outersurface of the elongate member.
 3. The method of claim 1, furthercomprising occluding at least one of the at least one side opening orthe at least one distal end opening with the balloon upon inflation ofthe balloon.
 4. The method of claim 3, further comprising maintainingthe balloon in an inflated state to prevent flow of fluid through the atleast one side opening and the at least one distal end opening.
 5. Themethod of claim 4, wherein delivering inflation fluid to the balloonincludes: filling the balloon with saline until the balloon expands to avolume sufficient to clear the occlusive material from the at least oneside opening and the at least one distal end opening and to completelyocclude the at least one side opening and the at least one distal endopening.
 6. The method of claim 1, further comprising deflating theballoon.